form of metastasis of gout to the brain, in which it is not difficult to discern the first stage of oppression. If it proceed to complete apoplexy, the symptoms do not vary from those of its ordinary form. When cerebral disturbances occur, it will generally be found that the urinary and hepatic secretions are either totally or partially suppressed. Matters, which should be eliminated from the body, thus retained in the system, never fail, even in a more moderate degree, to excite great disturbance, of which we shall find ample evidence as we proceed with our inquiry.'

Let no practitioner neglect the slightest warnings of these aberrations of gout. He who does so, however often he may escape without blame and without harm, will surely at last be caught in disgrace and calamity. His patient, lulled into a false and fatal security, will undertake duties which he ought studiously to avoid, for which he is wholly unfit, and will break down at

1 'The head metastasis of cough, however, sometimes occurs under the form of the most violent cerebral irritation, the pain being seated either in the internal periosteum, or in the membranes of the brain. I have described such a case (Deutsche Klinik, 1854, p. 22), in which after the suppression of a regular gout, a metastasis to the head, with violent irritation of the cerebral membranes, came on, and recurred periodically. After fourteen years of this condition, the regular gout was restored by means of our mineral waters." (Braun's Translation.)

the moment when all his strength is most needed. The case of a late eminent German statesman, who sank under this form of gout amidst the most critical affairs of his country, is a striking illustration of the weakness and the risk which lurk under apparent strength in this deceitful condition.

CHAPTER IV.

THEORY OF A MORBIFIC MATTER-INDIGESTION-OPINION OF CULLEN STAHL-URIC ACID DIATHESIS-ORIGIN OF URIC ACID

AND

ITS PRESENCE IN HEALTHY. BLOOD.

THERE is not any disease to which the old humoral pathology has left a richer legacy of error than this of gout. It pervades all the language we use, whether in speaking or in writing, and, as usually happens in such cases, through the terms we employ, confusion and mistake reach our thoughts. A late able writer on gout, indeed, openly avows his belief in the existence of a materies morbi, and he has since been followed by others not less eminent than himself.

In describing this disease, we are almost irresistibly led to employ a figurative and somewhat poetical language. Its phenomena readily adapt themselves to the metaphor of a surging mass, a coction, or a wandering vapour, and authors endow its assumed matter with a kind of separate existence, describing its wanderings to and fro, up and down in the body, till it chooses its local habitation, there to mature its strength, exhaust its fire, and thence be eliminated from the system. These

fanciful speculations no doubt afford a very ready solution of some appearances. They seem to account for the preceding discomfort and disturbed health of the patient, for his gradually increasing uneasiness, and for the sudden vanishing of many symptoms simultaneously with the explosion of the local disease. But it is surely a violation of all the best rules of philosophy to explain obscure phenomena by means of an assumed principle or fact of at least doubtful existence- notum per ignotum, obscurum per obscurius.

The notion of a morbid poison is not altogether without practical consequences. If it therefore be an error, it cannot be so immaterial to admit its existence, as the partisans of this opinion presume. We are much more frequently called to witness and prescribe for the atonic symptoms than for that form of gout which has received the name, and is believed to be the type of the regular disease. In such cases it is a popular and favorite idea, which even receives countenance from men of science, that much relief is always obtained by bringing on an attack of the regular disorder, and that this may be laid down as a rule of practice.1

"The error consists in confounding cause and effect. Certainly, the spontaneous development of a regular attack of gout in such cases is a good sign; not, however, because it transforms the disease from atonic to regular gout, but because it affords a proof that the

That such ideas are, for the most part, fallacious, and such hopes of benefit a miserable delusion, multiplied experience amply convinces. me. I do not deny that a paroxysm of gout is often accompanied by the relief of many symptoms which had previously distressed the patient. But, if its cause be viewed in the light in which I shall subsequently present it, a fit will by no means be always considered an advantage; on the contrary, the first and most earnest endeavours of the physician to bring the disease in its active and regular form under his control, will often have the effect, and sometimes the salutary effect, of giving it the atonic aspect above alluded to.

This idea of eliminating some offensive poison from the system not only pervades all our best treatises on gout, but may truly be said to govern the minds of many of our best practitioners. I

nervous life and the whole constitution are so strengthened that they react powerfully against the gouty irritation, and are able to bring to pass such a regular attack as is frequently followed by relief. Hence, a physician, and especially a physician to a watering-place, can fall into no more serious error than to labour for a paroxysm in such debilitated patients whose gout is atonic, or has entered the second stage. It is easy to succeed in producing a gouty irritation of the extremities; but the patient becomes worse and weaker than before. While, on the other hand, it is a very cheering sign when a thorough scientific thermal treatment is subsequently followed by a regular and severe attack of gout, producing an alleviation." (Braun's Translation.)